is the first evidence of HBV infection; will remain positive in asymptomatic carriers and chronic hepatitis B pts

Viremia

Viremia viruses enter the bloodstream and hence have access to the rest of the body.
can also indicate an elevation of virus levels occurring
It is similar to bacteremia, a condition where bacteria enter the bloodstream.

HBsAg

Ag= always growing

HBeAg

eAg= extra contagious, always growing

Anti-HBc

antibody to HBcAg

doesn't mean much

HBeAg

Extra Growing, Extra Contagious

protein derived from HBV core, indicating circulating HBV and highly infectious sera) is found only in HBsAg positive ser. Its presence indicated viral replication and infectivity.

Anti-HBe

often appears after HBeAg disappears. It signifies diminished viral replication and decreased infectivity

An enzyme immunoassay detects the presence of antibodies to Hepatitis C, sensitivity and specificity are low, and when highly suspected, which assay detects antibodies to HCV antigens?

RIBA assay detects antibodies to HCV antigens

To differentiate prior exposure from current viremia for Hep C, use?

PCR
Polymerase chain reaction

HBsAg, Anti-HBc, Anti-HBe, IgM, IgG?

Chronic Hep B

IgG and IgM at the same time-indicates chronic
AntiHBe- diminished viral load

HBsAg, HBeAg, Anti-HBc, IgM?

Active Hep B

Anti-HBc, Anti-HBsAg?

Recovered Hep B

Anti-HCV, HCV RNA

Acute Hep C
Chronic Hep C
Serologies are the same, so have to order a PCR TO DIFFERNTIATE PRIOR EXPOSURE FROM CURRENT VIREMIA

Anti-HAV, IgG

Recovered Hep A

Anti-HAV

never had hep A, still susceptible

Name the acute Hep B markers?

HBsAg
HBeAg

Anti-HAV, IgM

Active Hep A

Active viremia

is caused by the replication of viruses which results in viruses being introduced into the bloodstream. Examples include the measles, in which primary viremia occurs in the epithelial lining of the respiratory tract before replicating and budding out of the cell basal layer (viral shedding), resulting in viruses budding into capillaries and blood vessels.

HBsAb

Anti-HBs
B=bye, no HBV on board,

hx of immunization OR a protective antibody, unable to get HBV in the future

Hep A & Hep B and post exposure prophylaxis with IG for close contacts (Hep B=HBIG)

HBV surface antigen abbreviation?
Definition?

(HBsAg) is the surface protein of HBV. The HBsAg itself is not an infectious agent but its existence shows that there is HBV in the body of the patient. (It has the same meaning as having detectable HBV DNA in the blood.) HBsAg can exist in blood, saliva, breast milk, sweat, tears, nasal secretions, semen, and vaginal secretions.

When does the HBV surface antigen become positive in the serum?

within 2 to 6 months of the initial HBV infection and usually two to eight weeks before ALT and AST elevation. In acute HBV infections, it can turn negative in the early stage of the disease course. In chronic hepatitis B patients, this marker can be persistently positive.

The HBV surface antibody abbreviation?
Definition?

(HBsAb) is the product of the body’s immune reaction to the HBV infection. It is an immune globulin secreted by B lymph cells that can combine with the HBsAg to neutralize it. Along with other immune reactions, the HbsAb protective antibody can eradicate the invading HBV from the body.

What can cause the HBsAb marker to be positive?

Either an HBV infection or HBV vaccination can cause the HBsAb marker to be positive.

How long will the HBsAb exist?

This antibody can exist in the blood for a long time, gradually decreasing with age. If the HBV infection happened during the infancy period, it is likely to become chronic since the infant is unable produce this antibody at that time.

The HBV e antigen abbreviation?
Definition?

(HBeAg) comes from the core of the HBV and is a portion of the core. When the core of the HBV degrades in the serum, this antigen is created and can be detected. Because HBcAg will be totally degraded in the serum, it is not detectable in the serum.

Significance of the HBV e antigen?

Thus, when the HBeAg marker becomes positive, it is equivalent to a positive HbcAg marker and shows that the Hepatitis B virus is replicating actively and the patient is infectious.

The HBV e antibody abbreviation?
Definition?

(HBeAb) is the body’s immune reaction to the HBeAg and like HbsAb, it can combine with the HbeAg. It usually appears after the HBeAg turns to negative, which also means that the HBV replication activities have decreased and the patient is less infectious or not infectious at all.

Name sign elicited by gently but deeply palpating an area of abdominal tenderness then rapidly releasing the pressure, pain is typically worse wit release, indicating abdominal wall and/ or peritoneal inflammation?

Blumberg (rebound tenderness)

Name sign elicited when pain referred to the right when direct pressure applied to LLQ?

+ Rovsing's sign

Name of sign elicited if pain when pt raises rt leg against resistance?
Suggestive of peritoneal inflammation (appendicitis)

+ Psoas sign

Name sign elicited when pain when the rt hip and knee are flexed and thigh is rotated inward?
Suggestive of peritoneal inflammation (appendicitis)

+ Obdurator sign

Mc Burney's point

the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the navel. This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum

Name sign elicited when pain when pt is asked to stand on tiptoes, then lets body weight fall quickly onto the heels. The sign is positive if abdominal pan increases and localizes with the maneuver and suggestive of peritoneal inflammation.

Markel's sign

Cullen's sign

superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
This sign takes 24-48 hours to appear and can predict acute pancreatitis. Also seen in ruptured ectopic pregnancy

Grey Turner's sign

Grey Turner's sign (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.

It is useful for differentiating pain in the right upper quadrant. Painful arrest of inspiration triggered by palpating edge of inflamed gallbladder. Typically, it is positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis and ascending cholangitis.

(Palpating deeply and quickly pulling back can cause a catecholamine rush in elderly- MI)

fecolith

stone in wall have an 8 hr window with appendix- surgical consult

leukocytosis

WBCl count (the leukocyte count) above the normal range in the blood.It is frequently a sign of an inflammatory response, most commonly the result of infection, and is observed in certain parasitic infections. It may also occur after strenuous exercise, convulsions such as epilepsy, emotional stress, pregnancy and labour, anesthesia, and epinephrine administration.

The acid from the stomach worsens the pain, whereas food usually relieves duodenal ulcers, because, by the time the acid gets to the duodenum, it's already buffered.

Peptic ulcer

a sore on the lining of the stomach or duodenum, the beginning of the small intestine

hematemesis

bright red blood in vomitus

it's implied that it didn't reach the level of the duodenum as it's still bright red

coffee colored stool implies

it was beyond the level of the duodenum, as the food was partially digested

melena

melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin);

Erosive gastritis

Erosive gastritis is a type of gastritis that often does not cause significant inflammation but can wear away the stomach lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive gastritis may be acute or chronic.

Where's Chron's dx typically found?

RLQ
anywhere in GI tract, but most commonly in the terminal illeum and proximal colon

With ETOH abuse AST is usually more than 2 times greater than the ALT. In pts who abuse ETOH daily, the ALT and AST may be normal. GGT (gamma-glutamyl transferase, is often elevated even when ALT and AST are normal.

Hirschsprung's dx is characterized by?

no meconium w/i forst 48 hrs of life
aganglionic megacolon
the affected segment of the colon is absent of ganglia that's responsible for producing peristalsis. Not diagnosed until 48 hrs of life

S/S of Hirschsprung's?
Tx?

Emesis
abdominal distension
failure to pass stool
abd x ray will demonstrate distal intestinal obstruction wiht dilated bowel loops
should be referred for surgery to remove the diseased part of the colon

Pyloric stenosis?

more common in males
usually diagnosed b4 the child is 12 weeks old.
infant who vomits immed after eating
Knot in the ab typically olive shaped mass palpable at the lateral edge of the rectus abdominus muscle in the RUQ of the abdomen. Mass is best palpated immed after vomiting